This study's long-term objective is to improve the quality of in-hospital nursing care for patients with advanced-stage illness. The evaluation of quality in a hospital has been conducted mostly from the perspective of health care providers, while patient-centered evaluation, particularly quality evaluation by hospitalized patients with advanced illness, is largely missing. To improve the quality of nursing care for patients with advanced illness, it is vital to understand what quality nursing is for them and to have instruments that meaningfully evaluate the quality of care in this population. The specific aims of this proposal are: 1) to develop the concept of quality of nursing care from the perspective of patients with advanced illness, and 2) to develop a preliminary form of an instrument to evaluate the quality of nursing care from the perspective of patients with advanced illness. In the first phase, the concept will be developed through an extensive literature review integrated with semi-structured interviews of hospitalized patients with advanced-stage illness to identify domains and attributes. Fifteen to 25 hospitalized patients with advanced-stage illness will be recruited from adult oncology and medical-surgical units in an academic medical center. Care managers in these units will identify potential participants who meet the inclusion criteria (>18 years old with one or more of: stage IV cancer, advanced-stage lung disease, renal failure, liver failure, or heart failure). Patients will be included if they speak English, stay in the hospital >3 days, and have had at least two prior hospital admissions with any diagnosis in the proceeding 12 months. During their visits to patients, care managers will distribute a cover letter and a flyer describing the study to eligible patients. The researcher will visit interested patients to determine their eligibility for participation and schedule a time for an interview. The interview will take place in the hospital room or a location chosen by each participant. Interviews will take approximately 30 minutes, will follow an interview guide and be audiotape-recorded. Audio records will be transcribed verbatim and qualitative content analysis will be conducted. Based on the concept of quality of nursing care defined in the first phase, questionnaire items and a preliminary instrument to evaluate quality of nursing care for patients with advanced illness will be developed (phase II). Clarity and validity of this preliminary instrument will be reviewed by the health care experts and 8-12 cognitive interviews of patients with the same inclusionary conditions specified in the concept-development phase. [unreadable] [unreadable] [unreadable]